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General NPI Number Information
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NPI Number | 1740642628
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Entity Type | Organization
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Legal Business Name | KPR ENDOCRINOLOGY LLC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 621 PLAINFIELD RD ST 107
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5343
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Country | US
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Telephone | 708-446-7527
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Fax |
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Provider Business Mailing Address
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Address Line | 20 GLENDALE AVE
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City | HINSDALE
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State | IL
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Zip | 60521-2829
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Country | US
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Telephone | 630-487-3736
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Fax | 630-487-3738
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SUDHA K YALAMANCHI
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Credential | M.D.
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Telephone | 630-487-3736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 036121291
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License Number State | IL
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